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Gastrointestinal cancers are primarily diseases of persons in their sixth, seventh, and eighth decade of life. Both incidence and mortality of gastrointestinal cancers increase with advancing age (Figures 98-1 and 98-2). Many elderly persons, however, have additional medical problems that almost certainly contribute to this inferior outcome. This chapter will explore the epidemiology, presentation, treatment options, and disparities in the care of older persons with gastrointestinal malignancies.

Figure 98-1.

Percentage of incident cases by age group for GI malignancies (2000–2003), adjusted for 2003 U.S. census.

Figure 98-2.

Mortality rates for GI malignancies (2000–2003) by age at death.

In general, the symptoms and presentation of gastrointestinal cancers in older individuals appear similar to those of persons of younger age. Although treatments for these cancers have been developed primarily in younger patients, greater expertise over time has permitted similarly safe and efficacious therapy to be extended to older age groups. Since the greatest percentage of gastrointestinal cancers are located in the colon and rectum, most of the information regarding older persons focuses on colorectal cancer. Unfortunately, there is a paucity of information concerning the treatment of elderly patients with other gastrointestinal malignancies. In this chapter, gastrointestinal malignancies are ordered by incidence in the U.S. population.

Colorectal cancer accounts for approximately 10% of all new cancer cases and 10% of all cancer-related deaths in the United States. In fact, colorectal cancer causes more deaths than prostate cancer in men 60 to 79 years of age and more deaths than breast cancer in women 80 years or older. In 2008, 108,070 new cases of colon cancer and 40,740 new cases of rectal cancer will be diagnosed. The probability of developing colorectal cancer increases from 0.07% in the first four decades of life to 4.3% for females and to 4.8% for males in the seventh decade of life. Although the 5-year relative survival (66%) with this cancer is identical for persons younger than 65 and for persons 65 to 74 years, it declines to 60% for individuals 75 years or older (Figure 98-3 and Figure 98-4).

Figure 98-3.

Five-year survival rates for GI malignancies by age group.

Figure 98-4.

All-stage 5-yr survival by age group for colon and rectal cancer.

Six out of seven studies suggest that elderly patients present at the time of diagnosis with the same probabilities of having localized and advanced colon cancer as younger patients. In randomized studies, elderly patients are reported to have the same performance status and incidence of tumor-related symptoms as younger patients, but tend to have more disease-related weight loss. Older patients also appear to have a greater incidence ...

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